MEDICARE: ERLINDA PENALOSA MERCADO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	EM031514	MI
2	2084P0800X	Psychiatry Physician	64604	CT
3	2084P0800X	Psychiatry Physician	83466	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00027113	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2606386671	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1790898278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERLINDA PENALOSA MERCADO M.D.

Provider Business Mailing Address
First Line	:	2000 CHAMBERS ROAD
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-9296
Country	:	US
Telephone Number	:	989-673-3191
Fax Number	:	989-673-0064

Provider Business Practice Location Address
First Line	:	PO BOX 351
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-7023
Country	:	US
Telephone Number	:	860-395-5042
Fax Number	:	860-395-5058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	01/13/2025

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